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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; m ; c <br /> APPLICATION FOR — LAND USE — PERMITS3' <br /> m � <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of theCID <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wis;7sin. <br /> ��t✓ I i�l Il�-I�.- /� ( JA.�- 0 O <br /> c(l'f✓r� ' " 11,1 . , i1�YIrL f <br /> OTTER(PI ase Prir!, Contrail r or Su, eyor or alit m <br /> Add�rressAdX11 dres <br /> s"Y� IIx f (ALL W&L <br /> City, State,Zip Code City, State,Zip Code QS <br /> Telephone Telephone 1 <br /> J <br /> Emergency/Fire No. and Road Name <br /> Legal Description (as Indicated on tax statement) <br /> � o <br /> Permit(s)Applied for: 0 =- <br /> Dwelling Addition Filling/Grading Camping Unit ° 3 <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision i <br /> Garage �nn <br /> r ' <br /> Structure Use: I °r ?, <br /> (family home/cabin, garage,addition,etc.) ti <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings(NB) and Indicate North (N). O 3 <br /> 2. Show the location of the well (W),septic tank (ST), and drairdield (DF). on <br /> 3. Show dimensions In feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building z V o <br /> measurement to the ordinary high water mark of lake,stream,or river. ` n <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. C 9 W , <br /> PLOT PLAN <br /> ch <br /> A4,7 <br /> c/ a ),1 <br /> 0 <br /> o <br /> n <br /> m ` <br /> 91 <br /> O /fit y <br /> w <br /> I son ,�Ll e <br /> 5 i "Y <br /> aN A M <br /> �^ < � d ,e <br /> coo ice' ; <br /> OZ <br /> m o i .0 .20 <br /> i <br /> f = N: M <br /> m � C <br /> 8 i m i a <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief itis true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- It ` O <br /> !!nn tv" <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 i $ m $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication.Iagree to permit county officials charged with administering county ordinances or other authorized person to have m � <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 g 8 W <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> o . x : <br /> i \ $ i <br /> ZONING ADMINISTRATOR <br /> MN NNN T <br /> TOWNSHIP PERMITS MAY BE REQUIRED 8 8 8 8 8 8 8 8 m <br />